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March 26, 2014

News From ACFAS


New Online Clinical Session on Forefoot Now Available
Take advantage of free online education from ACFAS with the new Clinical Session, “Focus on the Forefoot,” where you’ll gain knowledge on arthritis of the 2nd MPJ, the rheumatoid forefoot, treating sesamoid pathology, non-traditional approaches to Hallux Rigidus and Brachyetatarsia.

This online seminar, hosted by member clinical experts in the area of forefoot surgery, discusses treatment options of common presenting conditions that have a variety of treatment options.

To view, visit acfas.org/e-learning and choose Clinical Sessions.

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Get Early Access to JFAS Articles before They’re Published
As a member, you can be one of the first to read the latest research before its published in JFAS. For access, visit the Journal of Foot & Ankle Surgery's online home page at acfas.org/jfas and click “Read Current and Past Issues Online,” then "Articles in Press." New articles are available as soon as their proofs have been approved — even before they're assigned to an issue.

Enjoy tomorrow’s news today, including original research, case reports, tips, quips and pearls. It's quick and easy with your free member access!
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Foot and Ankle Surgery


Study Generally Finds Comparable Outcomes for Outpatient, Inpatient Orthopaedic Surgeries
A study presented at the American Academy of Orthopaedic Surgeons' (AAOS) Annual Meeting on March 13 found that the outcomes for inpatient and outpatient orthopaedic surgeries are generally similar. Researchers reviewed the outcomes of 243 patients who underwent either type of surgery and found that there was no statistically significant difference in the number of patients who underwent outpatient procedures who were readmitted to the hospital 30 days after surgery and the number of patients who underwent inpatient procedures and were subsequently readmitted to the hospital. In addition, the study found that the length of a patient's hospital stay had no effect on his satisfaction with the procedure.

From the article of the same title
Medical Xpress (03/13/14)
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Comparison of Surgical Techniques of 111 Medial Malleolar Fractures Classified by Fracture Geometry
A recent study examined the effectiveness of several different types of surgical techniques in treating various kinds of medial malleolar fractures. The 111 medial malleolar fracture patients who took part in the study were treated with buttress plate, lag screw, tension band, or K-wire fixation, and were subsequently evaluated. The study found that tension band fixation resulted in the highest rate of union, the highest average American Orthopaedic Foot & Ankle Society (AOFAS) score, the lowest revision rate, and the lowest complication rate in patients with transverse fractures. Lag screws, meanwhile, brought about the highest rate of union, the lowest revision rate, and the lowest complication rate in patients with oblique fractures. Finally, the study found that buttress plating achieved union in all the cases of vertical fractures. Vertical fracture patients treated with buttress plating had an average AOFAS score of 84, a 17 percent complication rate, and did not need any revisions.

From the article of the same title
Foot & Ankle International (02/14) Ebraheim, Nabil A. ; Ludwig, Todd; Weston, John T.; et al.
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Practice Management


ICD-10 and EHR Fuel Clinical Documentation Improvements
Healthcare industry observers say that the Systemized Nomenclature of Medicine Clinical Terms (SNOMED CT), which meaningful use stage 2-complaint electronic health record systems are required to generate, will help bring about improvements in clinical documentation. EHR systems that did not include SNOMED CT supported a number of different encoding systems, which generally made interoperability and the sharing of problem lists impractical. SNOMED CT attempts to address these and other issues by requiring different EHR systems and the physicians who use them to use a standard method for encoding problem lists. In addition, the Centers for Medicare and Medicaid Services (CMS) is developing clinical quality measures that use some of the SNOMED terminology to define the numerator and the denominator of a particular patient that has been diagnosed with a certain condition. A patient with a fractured right leg, for example, would be assigned three concepts--a right concept, a leg concept, and a fracture concept--under SNOMED. This allows physicians to take the codes that represent the conditions they care about, click on those concepts, and automatically generate the codes that are needed to represent the appropriate diagnosis. The improvements in clinical documentation that SNOMED CT brings about will be particularly important this year, experts say, given the switchover to ICD-10 on Oct. 1 and the end of the year deadline for adopting meaningful use stage 2.

From the article of the same title
Health Leaders Media (03/18/2014) Mace, Scott
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Doctors, Device Makers: Close Ties
The relationships between medical device makers and doctors is one of the issues in the thousands of product-liability lawsuits that have been filed against Johnson & Johnson's Ethicon unit due to problems with the company's transvaginal mesh products. E-mails and other documents that have been brought to light during the legal proceedings indicate that Dr. Vincent Lucente, an Allentown, Pa.-based urogynecologist, attempted to convince the American College of Obstetricians and Gynecologists (ACOG) to drop the use of the word "experimental" from the guidelines its wrote about the use of the transvaginal mesh. Dr. Lucente was concerned that patients would not want to use the product if they believed it was experimental. ACOG has said that it removed the word "experimental" from its guidelines in response to complaints from its members that the meaning of the term was unclear, and that it does not know whether Dr. Lucente--who was paid roughly $800,000 over a 10-year period to educate doctors about the safety and effectiveness of Ethicon's products--was one of those members. Johnson & Johnson has denied being involved in the effort to lobby ACOG to drop the word "experimental" from its guidelines. The documents also indicate that Ethicon attempted to influence how a researcher whose university received grants from Johnson & Johnson discussed the adverse events associated with the transvaginal mesh in a study of the product. Johnson & Johnson has said Ethicon did not try to inappropriately influence the study's results or its conclusions.

From the article of the same title
Wall Street Journal (03/13/14) Wang, Shirley S.
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Health Policy and Reimbursement


Doc Fix Before March 31 Appears Unlikely
A staffer for a Republican member of the Senate says it does not appear Congress will pass a permanent repeal of the Medicare sustainable growth rate (SGR) formula before the end of the month, when the current temporary doc fix expires. At issue is how to pay for the repeal of SGR. A staffer for Sen. Ron Wyden has said that Oregon Democrat is considering using funding for military operations to help offset the $180 billion, 10-year cost of the Senate's SGR repeal bill. However, Republicans are not likely to support the use of funding for military operations to pay for the repeal of SGR, and it remains unclear whether there are enough Democrats in the Senate who would be willing to vote for the measure. As a result, the Senate may not even vote on an SGR repeal bill before March 31. However, Wyden's spokesman says he is still focused on drumming up bipartisan support to fully repeal and replace SGR. With the chances of passing an SGR repeal bill before March 31 seemingly remote, the focus now shifts to passing another patch to prevent the 24 percent cut to doctors payments from going forward. The House plans to vote for a patch sometime this week, though it is unclear how long a period the patch would cover.

From the article of the same title
Modern Healthcare (03/24/14) Demko, Paul
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Reform Update: Doctors Urge CMS to Issue Rule on Premium Grace Period
The American Medical Association (AMA) and dozens of other physician groups sent a letter to Centers for Medicare and Medicaid Services (CMS) Administrator Marilyn Tavenner earlier this month asking her to develop new requirements that govern the notifications healthcare providers are given about whether or not patients who have enrolled in subsidized health insurance exchange plans have paid their premiums. Under the current rules, insurance companies are required to notify healthcare providers that their claims could be denied when patients are in the second or third month of a 90-day grace period that allows them to obtain care before paying their premiums. But the AMA and other physician groups said in their letter that insurance companies have too much freedom in how and when they issue such notices, adding that this could result in "administrative confusion" for doctors. The AMA and the physician groups also note that CMS' decision to allow insurers to classify claims as pending during the second and third months of the 90-day grace period will force physicians to swallow the cost of treating patients who have not paid their premiums. In addition to asking for new requirements for notifications about patients' payment status, the groups also want CMS to make insurers pay for claims if they provide incorrect information about whether or not a patient has paid his premiums during the second and third months of the grace period.

From the article of the same title
Modern Healthcare (03/17/14) Robeznieks, Andis
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CMS Wants Improper eRx Payments Back
The Centers for Medicare and Medicaid Services (CMS) says that improper payments were made through its Physician Quality Reporting System (PQRS) and the Electronic Prescribing Incentive (eRx) Program as a result of problems with the integrity of data submitted through those programs. CMS says it wants to recover any improper payments that were made through PQRS and eRx. In addition, CMS says it will launch a four-year project in which it will analyze data submission, processing, and reporting for possible errors, inconsistencies, and gaps. This analysis will specifically focus on problems with data handling, program requirements, and clinical quality measure specifications, the agency says. CMS also plans to identify potential steps that can be taken to prevent the errors that led to the improper payments. The problems with eRx and PQRS come as e-prescribing systems are becoming more popular. A report from Surescripts found that there were a record 788 million electronic prescriptions in 2012, up from 570 million the year before.

From the article of the same title
Fierce HealthIT (03/17/14) Hall, Susan D.
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CMS Reminds PQRS Participants of Upcoming March Deadlines
The Centers for Medicare and Medicaid Services (CMS) says group practices that are participating in the physician quality reporting system need to be aware of several upcoming deadlines for the program, beginning with the March 21 deadline for groups to submit 2013 data through the Group Practice Reporting Option (GPRO) website. By the end of March, both group practices and eligible professionals will have to submit 2013 PQRS data through the registry reporting method. March 31 is also the last day for Maintenance of Certification Program Incentive entities to send in 2013 quality data, as well as the deadline for Qualified Clinical Data Registries to submit measure information for 2014 participation. CMS says there are other important PQRS program dates between now and 2016 which eligible professionals and group practices can stay abreast of by using its PQRS interactive timeline.

From the article of the same title
EHR Intelligence (03/12/2014) Freeman, Nicole
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Medicine, Drugs and Devices


Perioperative Statin Therapy Helps Reduce VTE Complications
A new study has found that statins can significantly reduce the risk of venous thromboembolic (VTE) events after total joint replacement surgery, when they are used in tandem with conventional blood clot prevention therapies. The study found that only 7.7 percent of the 196 patients who took a statin before and after a total joint replacement surgery had suffered a VTE after an average follow-up period of 11 months, compared to 14.5 percent of the 221 patients who did not take statins. The orthopaedic surgeons who performed the study said the lower rate of VTEs in patients who took statins may be the result of the drugs' pleiotropic anti-inflammatory effects. The study's lead author cautioned that clinical practice should not be changed until a clinical trial can be performed to examine the effect statins have on the risk of VTEs in patients who undergo total joint replacements.

From the article of the same title
Drug Topics (03/18/14) Walker, Tracey
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Laser Method for Intraoperative Evaluation of Lower Extremity Alignment: Comparison of a Novel Technique to CT and a Conventional Method
Using a laser emitter to project the mechanical axis of a lower extremity is an effective technique for performing continuous intraoperative evaluation of lower extremity alignment following reconstructive surgery, a new study indicates. Researchers measured the alignment of 16 cadaver lower extremities using three techniques, including a laser method in which a laser emitting and laser catching device was positioned and centered on the femoral head and the ankle using an image intensifier. The laser was caught on the knee region to allow the actual mechanical axis of the lower extremity to be marked. The other two methods used were the electrocautery cable method and Computed Tomography (CT) scans. Researchers observed good correlation of the laser method compared to the cable method, though there was no statistically significant difference between the three methods in terms of the average mechanical axis. The study also found that the laser method required significantly more radiation time than did the cable method.

From the article of the same title
Archives of Orthopaedic and Trauma Surgery (03/14) Hawi, Nael; Yarboro, Seth; Suero, Eduardo M.; et al.
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Cryoultrasound Therapy in the Treatment of Chronic Plantar Fasciitis with Heel Spurs: A Randomized Controlled Clinical Study
A new study has concluded that cryoultrasound therapy could be an effective form of treatment for patients with chronic plantar fasciitis, particularly those who have heel spurs that have been resistant to pharmacological and instrumental therapies. The 102 chronic plantar fasciitis patients who participated in the study all had painful symptoms for at least six months as well as Visual Analog Scale (VAS) scores higher than five. All of the participants also had heel spurs, were using plantar orthoses, and had not been helped by previous therapies. Patients were evaluated before being treated with either cryoultrasound therapy or cryotherapy, and were evaluated again at three, 12, and 18 months following treatment. The study found that the difference in pain intensity on the VAS scale after 12 months was 4.35 points in favor of the cryoultrasound therapy group. A statistically significant difference in the average VAS scores was also seen at three, 12, and 18 months, with patients in the cryoultrasound therapy group achieving better scores. Finally, the study found that only patients in the cyroultrasound therapy group were able to achieve scores of at least 66 percent on the effectiveness index, which was calculated by using the VAS scores recorded at the three and 18-month follow-ups.

From the article of the same title
European Journal of Physical and Rehabilitation Medicine (02/14) Vol. 50, No. 1, P. 39 Costantino, C.; Vulpiani, M.C.; Romiti, D.; et al.
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